Provider Demographics
NPI:1073955753
Name:ANDERSON, JORDAN MASSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MASSEY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36853
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6853
Mailing Address - Country:US
Mailing Address - Phone:702-644-3333
Mailing Address - Fax:702-644-3336
Practice Address - Street 1:2425 N LAMB BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-5420
Practice Address - Country:US
Practice Address - Phone:702-644-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor